Monday, January 11, 2016

The New State Hospital Annex

I have to preface this post with the opinion/viewpoint expressed here is purely my own and is not reflective of the organizations to which I belong.  That being said...
For several years, advocates in Wyoming have been doing their best to keep the state from closing the state's only ICF/IID, the Wyoming Life Resource Center (WLRC).  The state legislature has spent literally millions on studies trying to determine whether keeping the center open is a viable option and later, to determine the capital construction needs of the center; finally to determine how to construct a facility that will meet the new "mission" of the WLRC.  The plan is to add new cohorts to the facility - Title 25 (civil commitments) and geropsych patients.  This plan is the result of efforts of the Facilities Task Force (FTF) over the past two years.  As one can imagine, this is a multi-faceted issue.
First, what happens to those who are currently residents at the WLRC?  Some have been there nearly all their lives.  The Department of Health (DoH) determined forcible transition would put those people at risk so the FTF has created a "legacy population" who will be allowed to remain at the center. This legacy population is comprised of those with "organic brain syndrome" or acquired brain injuries, profoundly intellectually disabled persons with high medical needs, developmentally disabled persons with difficult behaviors, and those few higher functioning who have lived their entire lives at the center.  The projections provided by the DoH show that this population will decrease to almost zero (currently there are around 80 residents) in about 20 years due to mortality. I believe that the decision to create the "legacy population" was an attempt to placate the vocal advocates and guardians of the residents of WLRC.  In fact, during my public comment to the legislative committee which deals with health and social services issues, one of the chairpersons indicated that my concerns were unfounded in light of the guarantee of the "legacy population" and their ability to remain at the center, if they so choose.  But our concerns are not just about the "legacy population."
What about future generations of those with profound disabilities and high medical needs?  According to the state's analysts, the need for beds for these individuals will also decrease over time.  In fact, they've allowed only 10 beds at the WLRC for I/DD in the future, after the "legacy population" is no longer an issue. Studies show that there will be ever increasing numbers of children diagnosed with Autism Spectrum Disorder and that there has not been a decrease in the numbers of children born with cerebral palsy.  Nothing indicates a decrease in numbers of children born with a developmental or intellectual disability.  In addition, the population of our state is increasing in the number of elderly citizens; some of which are the parents of adults with I/DD. Common sense would be that this would create a need for an ICF/IID; especially considering that not everyone can be served at home or in the community. But that's a debate for another time. Suffice it to say, I believe there is a need for ICFs as well as home and community based services and that every individual with I/DD and organic brain syndrome (ABI/TBI) deserves integrated, client centered care and has a right to choose where to receive those services.  I also believe it is our responsibility, as a society, to ensure that every service provider is fully funded.
Due to changes made over the past 5 years, staff morale is very low.  Employees who might not have otherwise retired have jumped ship "before it sinks."  The DoH froze 100 positions last summer, leaving many positions unfilled.  Despite guardians' concerns, the state claims they are within staffing ratios and that residents are receiving the same care and services as they always have.  It simply is not true.  Our loved ones are not getting the equine therapy they once did.  There are times that individuals cannot attend aquatic therapy or go to day habilitation due to a lack of staff to take them to these services.  Clients who require one on one staffing often go without their one on one.  To accommodate the decrease in staffing, clients have been moved and are overcrowded in their cottages.  This overcrowding also causes safety concerns.  Equipment (wheelchairs, side-lyers, oxygen concentrators, etc.) fill the common areas and hallways.  At a recent meeting, one guardian summarized, "It is to the point of being inhumane." 
In anticipation of the legislature approving the changes to the mission of the WLRC, the DoH has hired a superintendent and a nurse practitioner with backgrounds in psychiatric services. The architects who performed the latest studies asked the FTF if they really wanted to move the gero-psych and Title 25 to Lander as those populations would require a new staff with a different skill set than the current staff at WLRC.  The superintendent has implied that future staff will be psychiatric nurses and paraprofessionals.
The FTF and DoH have also recommended statutory changes to reflect the new "safety net" mission of the State Hospital and WLRC. Part of the recommended option, in fact, stated it would eliminate guardian choice.  The section which ensured informed choice is being repealed. The multidisciplinary team which determines the appropriateness of placement at the WLRC is also being eliminated; making the DoH the only assessors of appropriateness.  The statutory changes also address the addition of the Title 25 and geropsych patients becoming residents at the WLRC, requiring licensure as a skilled nursing facility (SNF).  The state is waiting on a determination by the Centers for Medicaid/Medicare Services (CMS) as to whether a skilled nursing facility, with psychiatric beds, can be on the same campus as an ICF/IID and retain the reimbursements from CMS.  It is important to note that this change was precipitated by the spike in the number of Title 25 civil commitments in our state and the lack of available space at the State Hospital (psychiatric facility) for these and the geropsych patients.  It appears that the DoH intends to turn the WLRC into an annex of the State Hospital and eliminate the ICF/IID altogether, forcing individuals to receive services at home, in community programs, or in nursing homes. Ironically, the DoH just presented a Waiver Rebasing Report which calls for cuts in Medicaid payments for services in home and community based programs.
Next, let's talk about the legislature; more specifically the Joint Labor, Health and Social Services Committee (LHSS). Stay tuned.


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